MEDICARE: BRIANNA WISNIEWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-448669	IL

General Provider Information

NPI Number	:	1285431452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA WISNIEWSKI

Provider Business Mailing Address
First Line	:	707 LAKE COOK RD STE 307
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 LAKE COOK RD STE 307
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4967
Country	:	US
Telephone Number	:	414-087-7486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	06/10/2026

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Directions to “ BRIANNA WISNIEWSKI ” Practice Location

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